As more and more employers adopt high deductible health care insurance coupled with employee funded health savings accounts (HSAs), patients are becoming more responsible for their health care costs. However, often patients are uncomfortable asking about price information from their health care provider, particularly from their physician, for fear it will damage their relationship.
In addition, patients often do not have the knowledge to understand appropriate pricing of individual procedures. Also, it is often difficult for the provider and the patient to know prospectively all of the procedures or drugs which will be required for a certain course of treatment since those procedures or drugs may be changed during the course of the treatment. Furthermore, if procedures are individually priced, a patient selecting a provider based on an initial need might face higher total costs as previously unanticipated services become necessary. For example, if Dr. #1 charges $1000 for an appendectomy and $5000 for a cholecystectomy and Dr. #2 charges $2000 for an appendectomy and $2000 for a cholecystectomy, a patient thinking he or she needed an appendectomy might choose Dr. #1 for a lower price. Finding out later that a cholecystectomy was also necessary would have made Dr. #2 a less expensive choice, but by then the relationship had already been established.
Regarding medications, patients are best served by obtaining medications from a single pharmacy so as to avoid conflicting medications. Frequent price changes on medications, with some being loss leaders and others having higher prices, make it difficult for patients to obtain consistently good value.
The insurance reimbursement system which is now in place has created adversarial relationships between providers such as physicians and hospitals and insurance companies. Often insurance companies have a take it or leave it approach regarding reimbursements, which decreases provider panel size and, therefore, patients' choice of provider.
For rural communities, there is a significant distribution problem with provider services, in particular, physician services. There is also a decreasing availability of hospital services in rural communities. This is primarily due to insurance company reimbursement pressures.
In addition, the current insurance reimbursement system does not significantly recognize quality and customer service.